Healthcare Provider Details

I. General information

NPI: 1780521658
Provider Name (Legal Business Name): EMILY MYONG SOON SCOTTI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EMILY KIM

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9415 MONTGOMERY RD STE G
MONTGOMERY OH
45242-7641
US

IV. Provider business mailing address

9415 MONTGOMERY RD STE G
MONTGOMERY OH
45242-7641
US

V. Phone/Fax

Practice location:
  • Phone: 812-343-4853
  • Fax:
Mailing address:
  • Phone: 812-343-4853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2204682
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: